The Covid-19 pandemic has pushed the Nepali healthcare sector to the brink. The struggle of B&B Hospital and HRDC serves as an example on how hospitals need to work during a public health crisis.

In these tumultuous, uncertain and challenging Covid times, there must be thousands of individual stories of bravery, sorrow, triumph and despair. What has it been like at two hospitals (sister-hospitals to be sure) in Kathmandu and Banepa? How are they coping with the unique challenges of these times?
We are talking about B&B Hospital at Gwarko, Lalitpur and the Hospital and Rehabilitation Center for Disabled Children (HRDC) at Banepa. B&B Hospital is a general hospital that deals with steady volumes of trauma in all degrees of severity and complexity. HRDC is a charitable institution providing comprehensive treatment and rehabilitation to the musculoskeletally afflicted children, largely from poor socio-economic backgrounds from across Nepal. The B&B – HRDC symbiosis is unique. The specialist services required by HRDC are provided almost free by those working at B&B, and this results in tremendous cost savings for HRDC, which is a charitable institution.

After the pandemic slowly circumnavigated around the globe, we waited with bated breath for its arrival in our part of the world. The mortality havoc in the Americas and Europe was truly frightening! Were we in South Asia more immune to this virus? Could the mortality rates here be lower? And many speculated on the possibilities of the BGG vaccination. When it finally arrived, what was just news from other countries started to become a fact in our part of the world. The loads were lower and mortalities somewhat lower, it seemed at first. But a steady increase has been the trend with active cases increasing and death rates almost doubling in the past six months.

Being privately-run healthcare institutions, B&B Hospital and HRDC function under the guidelines of the government. Initially an early event meeting at Patan Hospital where B&B Hospital was designated as a satellite hospital and was required to refer Covid-19 cases to Patan Hospital. B&B Hospital swung into action and formulated a Covid team to establish safeguards and guidelines. An important initial step was patient screening right at the main entrance gate. A fever clinic, isolation-hold beds were urgently activated at the premises of the physiotherapy department which was shifted literally overnight into the causeway cum garage space below the canteen. Nurses were given pertinent instructions/training into the infective nature of the illness and all its unknown queries and on the common sense precautionary measures necessary.

In short, B&B Hospital went into ‘alert mode’ – it needed to continue to provide regular care that patients come for as well as attend to the challenging Covid scenario. An emergency meeting of the executive management deemed it of utmost importance for the hospital to rapidly establish its own molecular lab in the primary interests of safety to its patients and staff and as a service to the community. The rehab ward in the older building was quickly dismantled and a state of the art molecular lab set up in record time. The services provided by this lab have been nothing short of phenomenal to safely deliver care to both non Covid patients, screening purposes and Covid positive cases.

At HRDC, similarly a fever clinic has been setup at the gate. An isolation ward has been set up to screen patients who still take the trouble of travelling against odds in these difficult times to this miracle hospital on a hill top. Essential basic treatments, including surgery have been quietly going on through all these troubled times. In collaboration with local authorities, HRDC has participated in helping set up the regional quarantine facility by loaning hospital beds.  The screening PCR testing of all patients for HRDC are done at B&B Hospital lab.

Ambulances stream into the hospital steadily. A 70-year old lady has a hip fracture, a condition associated with significant risks for serious complications. Following the Covid protocols established, she is taken to the isolation ward, pending her PCR report, which, unfortunately, comes back as positive! Challenging decisions are made. Carefully planned and orchestrated protocols are put into action. Dr. Bibek Banskota and his team perform the surgery without any complications and the patient makes a good recovery. The operating team quarantine her for five days and all are tested and come negative! Similarly, essential services in other surgical, obstetric, and medical subspecialties continue irrespective of the patient’s Covid status. This has been possible because of a well-planned "protocol- driven" model of care delivery fashioned for these extraordinary times.

Segregation of hospital spaces in the wards, operating rooms, critical care have all been nothing short of monumental challenges in a physical premise not designed to deal with such a highly infective virus. Had B&B Hospital's new construction been complete, logistics would have been much more easily handled, but the hospital managers have tackled the challenges to segregate the infected vs non-infected cases and manage their case efficiently and safely.

Expenses have spiraled as revenues have plummeted. The regular functioning capacity of B&B Hospital has been at record lows (30-40%) over the past nine months. The need to be specially equipped in the current scenario has placed the hospital's finances under greater stress. Disposables of every kind, PPE suits, upgradation of high dependency units, separate ICU setup, organisation of specialist round the clock services etc. have all put the hospital finances under a great strain.  Recognising the risks for staff working in the Covid wards, special incentive schemes have been put into action. The hospital staff have also been insured but conflicting news in the media regarding the delivery of these benefits have saddened and cast doubts and frustration in the confusing manner in which directives issue forth from authorities.

There is a general misconception amongst a section of the general public and authorities in general that private hospitals unfairly take advantage of patients. Let us not get into the habit of generalising. Please judge each on its merits and demerits. Between HRDC and B&B Hospital, these two hospitals employ nearly one thousand staff. This equates to one thousand families! Juggling duties and reorganising services to this "Covid Mode", these hospitals have not laid-off a single employee, despite facing great financial pressure.

Also converting into a Covid hospital is easier said than done, especially because of those patients who come seeking care for other conditions. To care for patients, B&B Hospital has had to put into effect safety measures for the staff at risk. B&B Hospital has setup quarantine facilities at its Nursing School and this is an example where exposed staff recuperate, being provided meals and care by the hospital.

B&B Hospital today has 29 Covid beds including ICU with 4 ICU meds specifically for Covid only patients. The hospital has set aside nine isolation beds for pre-PCR patients before they can be admitted. To date, 96 staff of the hospital have tested positive for Covid-19 while they were on duty. All staff working in the frontline are tested and a special quarantine zone has been setup across the hospital at BMI nursing college. Till date, 92 Covid positive cases have been admitted and four operated on.  16 doctors have also tested positive and become unwell, requiring hospitalisation. Dr Philip Ranjit, one of our physicians who contracted Covid on duty, had to be hospitalised for chest issues, but has now bounced back in action to serve the Covid patients frequenting our special wards in increasing numbers. We express great pride in all our frontline staff who have selflessly served the hospital and patients during these trying times.
As verbalised by Dr Banskota, "an occasional depressing scene is the arrival of the army truck to receive a deceased corpse. It's all
bundled up in a zipped bag and remains in the mortuary, awaiting the army pickup. It's a sad and lonely goodbye for the departed one. No family is generally around and it's all business-like!"

But these are unusual times and what the future holds is uncertain. What is certain is that as hospitals, B&B Hospital and HRDC will continue to face these challenges for a while in the foreseeable future. And the experience will probably last a lifetime in all our memories.